Provider Demographics
NPI:1649380734
Name:KISOR, KIMBERLY LI CHING MICHIKO (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LI CHING MICHIKO
Last Name:KISOR
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Gender:F
Credentials:MD
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Mailing Address - Street 1:11200 SW MURRAY SCHOLLS PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-9816
Mailing Address - Country:US
Mailing Address - Phone:503-590-2241
Mailing Address - Fax:503-590-2211
Practice Address - Street 1:11200 SW MURRAY SCHOLLS PL
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-9816
Practice Address - Country:US
Practice Address - Phone:503-590-2241
Practice Address - Fax:503-590-2211
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-08-19
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Provider Licenses
StateLicense IDTaxonomies
OROR MD21827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH49034Medicare ID - Type Unspecified